cardiovascular-agents and Cognition-Disorders

Cardiovascular drugs are used to treat patients with cardiac function and hemodynamic problems. Because of the relationship between the cardiovascular (CVS), and central nervous (CNS) systems, alteration of CVS activity can potentially alter CNS function. Of particular concern is regulation of lipids, because of the link between neural functionality, lipids, and cognitive disorders, and perfusion, because of the link between hypo-perfusion and vascular dementia. Positive and negative evidence of the effect of CVS drugs in cognitive disorders is available. Awareness of the need to tailor treatments with CVS drugs to patients with consideration of gender, race, lifestyle, and co-morbidities is increasing. Evidence for the importance of cerebral perfusion in vascular dementia development is strong, supporting the importance of physician vigilance in the treatment of hypertension, particularly in vulnerable populations. Evidence for the role of plasma lipid control in development of Alzheimer disease is not as strong. However, physician vigilance in treating hyperlipidemias is strongly encouraged, particularly in vulnerable populations.

Topics: Animals; Cardiovascular Agents; Cardiovascular System; Central Nervous System; Cognition Disorders; Humans; Lipids

Elderly subjects with cognitive disorders are at particularly high risk of adverse drug reactions (ADRs). The objectives of our systematic review were to describe the prevalence of ADRs in elderly patients with cognitive disorders, the different types of ADRs and the medications suspected of involvement; to describe whether the ADRs were preventable or not, and to identify risk factors for occurrence of ADRs in this population. A bibliographic search was performed in the following databases: PubMed, Embase, Google Scholar, Opengrey and Scopus. The search included all publications up to and including 4th February 2015, with no specific start date specified. Studies concerning ADRs in elderly patients with cognitive disorders or dementia were included. Two senior authors identified eligible studies and extracted data independently. In total, 113 studies were identified by the bibliographic search, of which six full-text articles were retained and analyzed. Prevalence of ADRs ranged from 4.8 to 37%. The main ADRs reported were neurological and psychological disorders, gastro-intestinal disorders, dermatological and allergic disorders, falls, renal and urinary disorders, cardiovascular disorders, metabolic disorders and electrolyte imbalance, and hemorrhagic events. The medications most commonly suspected of involvement in the ADRs were drugs affecting the nervous system, cardiovascular drugs, anticoagulants, and painkillers. Medical prescriptions should take into account the presence of Alzheimer's disease and related syndromes. Compliance should systematically be evaluated, and cognitive disorders need to be better recognized. Therapeutic education of patients and/or their caregiver is key to management of elderly patients with cognitive disorders.

Topics: Aged; Analgesics; Anticoagulants; Cardiovascular Agents; Cognition Disorders; Dementia; Drug-Related Side Effects and Adverse Reactions; Humans; Prevalence; Risk Factors

Piper has been used for long timelike condiment and food, but also in traditional medicine around of the world. This work resumes the available and up to date work done on members of the Piperaceae family and their uses for therapeutic purposes.. Information on Piper genus was gathered via internet using scientific databases such as Scirus, Google Scholar, CAB-abstracts, MedlinePlus, Pubmed, SciFinder, Scopus and Web of Science.. The largeleafed perennial plant Piper is used for its spicy aromatic scent and flavor. It has an important presence in the cuisine of different cultures. Another quality of these plants is their known medicinal properties. It has been used as emollient, antirheumatic, diuretic, stimulant, abortifacient, anti-inflammatory, antibacterial, antifungal and antidermatophytic. A survey of the literature shows that the genus Piper is mainly known for its alkaloids with cytotoxic, chemopreventive, antimetastatic and antitumor properties in several types of cancer. Studies of its alkaloids highlight the existence of various potential leads to develop new anti-cancer agents. Modern pharmacology studies have demonstrated that its crude extracts and active compounds possess wide pharmacological activities, especially asantioxidant, anti-depressive, hepatoprotective, antimicrobial, anti-obesity, neuropharmacological, to treat cognitive disorders, anti-hyperlipidemic, anti-feedant, cardioactive, immuno-enhancing, and anti-inflamatory. All this evidence supporting its traditional uses.. This review summarizes the up-to-date and comprehensive information concerning the botany, traditional use, phytochemistry and pharmacology of Piper together with its toxicology, and discusses the possible trend and scope for further research on Piper in the future.

Topics: Alkaloids; Animals; Anti-Infective Agents; Anti-Inflammatory Agents; Anti-Obesity Agents; Antineoplastic Agents, Phytogenic; Antioxidants; Cardiovascular Agents; Cardiovascular Diseases; Central Nervous System Agents; Cognition Disorders; Humans; Neoplasms; Obesity; Piper; Plant Extracts; Platelet Aggregation Inhibitors

The prevalence of vascular cognitive impairment (VCI) is likely to increase as the population ages and cardiovascular disease survival improves. We provide an overview of the definition and disease mechanisms of VCI and present a systematic literature review of the current evidence for the pharmacologic and nonpharmacologic therapies used to treat the VCI symptoms of cognitive dysfunction or to modify VCI through primary and secondary prevention. The Cochrane Database of Systematic Reviews was searched from 2005 to October 2010 using the keywords "vascular dementia" or "vascular cognitive impairment and therapy." MEDLINE was searched for English-language articles published within the last 10 years using the combined Medical Subject Headings (MeSH) "therapeutics and dementia," "vascular" or "vascular cognitive impairment." Although cholinesterase inhibitors and memantine produce small cognitive improvements in patients with VCI, these drugs do not improve global clinical outcomes and have adverse effects and costs. Selective serotonin reuptake inhibitors and dihydropyridine calcium channel blockers may improve short-term cognitive function in patients with VCI. Anti-hypertensive therapy with an ACE inhibitor-based regimen and statins may prevent the major subtype of VCI known as poststroke cognitive decline. Clinical and effectiveness studies with long-term follow-up are needed to determine the benefits and risks of pharmacologic and nonpharmacologic therapies to prevent and treat VCI. Given its growing health, social, and economic burden, the prevention and treatment of VCI are critical priorities for clinical care and research.

Topics: Cardiovascular Agents; Cholinesterase Inhibitors; Cognition Disorders; Cognitive Behavioral Therapy; Dementia; Excitatory Amino Acid Antagonists; Humans; MEDLINE; Randomized Controlled Trials as Topic; Risk Factors; Vascular Diseases; Vitamins

As populations age, heart failure (HF) is becoming increasingly common, and in addition to a high burden of morbidity and mortality, HF has an enormous financial impact. Though disproportionately affected by HF, the elderly are less likely to receive recommended therapies, in part because clinical trials of HF therapy have ignored outcomes of importance to this population, including impaired cognitive function (ICF). HF is associated with ICF, manifested primarily as delirium in hospitalized patients, or as mild cognitive impairment or dementia in otherwise stable outpatients. This association is likely the result of shared risk factors, as well as perfusion and rheological abnormalities that occur in patients with HF. Evidence suggests that these abnormalities may be partially reversible with standard HF therapy. The clinical consequences of ICF in HF patients are significant. Clinicians should consider becoming familiar with screening instruments for ICF, including delirium and dementia, in order to identify patients at risk of nonadherence to HF therapy and related adverse consequences. Preliminary evidence suggests that optimal HF therapy in elderly patients may preserve or even improve cognitive function, though the impact on related outcomes remains to be determined.

Topics: Aged; Cardiovascular Agents; Clinical Trials as Topic; Cognition Disorders; Heart Failure; Humans; Risk Factors; Sleep

With aging comes an increasing prevalence of diseases and symptoms that frequently require pharmaceutical treatment. However, aging also brings about bodily changes that result in increased effects and prolonged action of many drugs. Multiple drug use--often termed polypharmacy--seen in many elderly individuals, is the most important risk factor for adverse drug reactions (ADR) and increases the risk of drug interactions and poor compliance. ADR's are responsible for about 10% of all hospital admissions of elderly patients. The drugs most commonly involved are cardiovascular, psychotropics and anti-inflammatory agents. Many of these ADR's are dose-dependent and preventable. Drug use has increased over the last few years, largely thanks to the availability of new and effective agents. This calls for increased vigilance and prudence in prescribing for the elderly.

Topics: Aged; Aging; Anti-Inflammatory Agents, Non-Steroidal; Cardiovascular Agents; Cognition Disorders; Dose-Response Relationship, Drug; Drug Interactions; Drug Prescriptions; Drug Utilization; Drug-Related Side Effects and Adverse Reactions; Humans; Polypharmacy; Psychotropic Drugs; Risk Factors

Revascularization of stenotic cerebral arteries is hypothesized to improve cognition by increasing cerebral perfusion.. We compared cognition impairment among patients treated with percutaneous angioplasty and stenting (PTAS) and aggressive medical management (AMM) versus AMM alone in the Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis (SAMMPRIS) Trial.. In SAMMPRIS, 451 patients with recent transient ischemic attack or stroke attributed to 70-99% intracranial stenosis were randomized to PTAS plus AMM or AMM alone. Patients who had stroke as the qualifying event with National Institutes of Health Stroke Scale indicating aphasia or neglect were excluded from these analyses. Patients with a cerebrovascular event (ischemic stroke, cerebral infarct with temporary signs or intracranial hemorrhage) during follow-up were excluded from follow-up visit analyses. The Montreal Cognitive Assessment (MoCA) score was used to assess cognition impairment at baseline, 4 months, 12 months and closeout. Cognitive impairment was defined as MoCA <26. Mean MoCA scores and the percentage of patients with cognitive impairment were compared between treatment groups at each time point using t tests and chi-square tests. Differences in MoCA mean at baseline and follow-up time points were compared using mixed model repeated measures ANOVA and Tukey-Kramer tests.. There were no significant differences between the treatment groups for mean MoCA at any time point. Mean MoCA scores improved in both groups. The percentage of patients with cognitive impairment in the AMM versus PTAS groups was not significantly different at any time point.. Revascularization with PTAS showed no improvement in cognitive impairment over AMM alone among patients who did not have recurrent cerebrovascular events during follow-up.

Topics: Angioplasty; Cardiovascular Agents; Chi-Square Distribution; Cognition; Cognition Disorders; Humans; Intracranial Arteriosclerosis; Neuropsychological Tests; Recovery of Function; Risk Factors; Stents; Time Factors; Treatment Outcome

To study the therapeutic efficacy and safety of Ginkgo special extract EGb 761 in the treatment of cognitive and non-cognitive symptoms (anxiety, depression, sleep disorders, activity) in patients with discirculatory encephalopathy (DE) and cognitive impairment.. The study enrolled 45 patients with DE (mean age 60,8±5,9 years). Patients were randomized to treatment with EGb 761 (30 patients) or other drugs (15 patients). Patients underwent neurological examinations, along with cognitive and neuropsychological testing (FAB, MMSE, HADS and other tests). EGb 761 was used in dose 240 mg per day during 24 weeks.. By the end of the study, the levels of anxiety and depression decreased (p<0,05) to the 12th and 24th week, respectively.. The results indicate the efficacy and good tolerability of EGb 761 in the treatment of mental disorders in DE patients with cognitive impairment. The best effect was observed in relation to anxiety.

Topics: Aged; Anxiety Disorders; Cardiovascular Agents; Cerebrovascular Disorders; Cognition Disorders; Depressive Disorder; Female; Ginkgo biloba; Humans; Male; Middle Aged; Plant Extracts; Treatment Outcome

To discuss the clinical effects of Western medicine therapy assisted by Ginkgo biloba tablet (GBT) on patients with vascular cognitive impairment of none dementia (VCIND).. A total of 80 patients with VCIND were divided into two groups randomly: Conventional treatment group (control group) and combined treatment group. Conventional treatment group was given conventional treatment with anti-platelet aggregation. In this group, 75 mg aspirin was given three times a day for 3 months. While in combined treatment group, 19.2 mg GBT was given three times a day for 3 months together with conventional treatment (anti-platelet aggregation drugs). Montreal cognitive assessment (MoCA) and transcranial Doppler (TCD) were used to observe changes of cognitive ability and cerebral blood flow in VCIND patients before and after treatment in both groups. Then the clinical data were analyzed so as to compare the efficacy in two groups.. After 3 month-treatment in combined treatment group, the scores of executive ability, attention, abstract, delayed memory, orientation in the MoCA were significantly increased compared with those before treatment and those in control group after treatment. Besides, blood flow velocity of anterior cerebral artery increased significantly than that before treatment and that in control group after treatment.. GBT tablet can improve the therapeutic efficacy as well improve cognitive ability and cerebral blood flow supply of patients with VCIND.

Topics: Aged; Aspirin; Blood Flow Velocity; Cardiovascular Agents; Cerebrovascular Disorders; Cognition Disorders; Drug Administration Schedule; Drug Therapy, Combination; Female; Ginkgo biloba; Humans; Male; Medicine, Chinese Traditional; Middle Aged; Plant Extracts; Platelet Aggregation Inhibitors; Psychological Tests; Treatment Outcome

Whether improvement of cognitive function can be maintained remains controversial.. This study aimed to investigate cognitive changes between before carotid endarterectomy (CEA) or carotid artery stenting (CAS) and 1 year after intervention using cognitive evaluation tools.. Patients suspected as having carotid stenosis were prospectively registered for evaluation of cognitive function from October 2011 to December 2013 in the Department of Neurosurgery, Fukuoka University Hospital. Cognitive evaluation by the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) were performed before and 1 year after CEA or CAS. Cognitive changes were evaluated using the Wilcoxon signed rank test, whereas the subscores of MoCA and MMSE were also compared.. The MoCA score was significantly ameliorated from 21 to 23 at 1 year after CEA (P = .003), but the MMSE score did not significantly change (24 to 25, P = .56). Additionally, the MoCA score was improved 1 year after CAS (P = .04), but it was unchanged in those who were treated medically (P = .15). Regarding the analyses of subscores, patients who had CEA improved in the areas of executive and memory functions, whereas those with medical treatment only showed improvement in memory. CAS did not improve any subscores. There was no significant improvement in the subscores of the MMSE in patients with CEA, CAS, or medical treatment 1 year after treatment compared with before treatment.. CEA or CAS may be significantly associated with cognitive improvement as evaluated by the MoCA. However, patients treated medically do not show improvement in cognitive performance.

Topics: Aged; Cardiovascular Agents; Carotid Stenosis; Cognition; Cognition Disorders; Endarterectomy, Carotid; Endovascular Procedures; Executive Function; Female; Hospitals, University; Humans; Japan; Male; Memory; Mental Status and Dementia Tests; Middle Aged; Prospective Studies; Recovery of Function; Registries; Risk Factors; Stents; Time Factors; Treatment Outcome

Heart Failure (HF) and cognitive impairment (CI) represent two high incident diseases worldwide, with extremely elevated mortality and morbidity rates. Their prevalence is expected to further increase in the next years due to the aging population, thus they pose enormous clinical, social and economic challenges. Sympathetic nervous system hyperactivity is known to play a pivotal role in HF pathophysiology and progression. In fact, increased cardiac and circulating catecholamine levels are responsible for several molecular and structural abnormalities with detrimental effects on the failing heart. The proof of this latter concept is represented by the clinical success of .-Blocker therapy that is able to attenuate HF-related morbidity and mortality. Recently, adrenergic system alterations have been implied also in the pathogenesis of CI and dementia opening the window for new fascinating and promising therapeutic opportunities.. Assess the state of the art on the relationship between cognitive impairment and heart failure.. In the present manuscript, we propose an updated review of literature and patent on the role of sympathetic nervous system derangement in the pathogenesis of HF and CI.. We have discussed recent findings allowing the identification of new molecular targets that hopefully will contribute to the generation of effective therapeutic strategies for HF and dementia. In this article, the patents US20100048479, US7060871, WO2006052857, US7351401, US5721243, WO1994009155, US5449604, WO1999058981, US5985581, EP2319511, EP2377534, EP2650303, WO2006004939, WO2010132128 and EP1779858 are summarized.

Topics: Adrenergic beta-Antagonists; Adrenergic Neurons; Age Factors; Animals; Brain; Cardiovascular Agents; Cognition; Cognition Disorders; Drug Discovery; Epinephrine; Heart; Heart Failure; Humans; Molecular Targeted Therapy; Nerve Degeneration; Neuroprotective Agents; Norepinephrine; Patents as Topic; Risk Factors; Sympathetic Nervous System

Topics: Aged; Anticoagulants; Atrial Fibrillation; Cardiovascular Agents; Cognition Disorders; Comorbidity; Fibrinolytic Agents; Heart Failure; Heart Rate; Humans; Inpatients; Patient Selection; Practice Guidelines as Topic; Prevalence; Prospective Studies; Risk Factors; Spain

No information exists, to our knowledge, about the possible role of cardiovascular drug administration in the acute phase of ischemic stroke and possible effects on stroke outcome. The aim of our study was to evaluate the relationship between in-hospital treatment with cardiovascular drugs in patients with acute ischemic stroke and some outcome indicators.. 1096 subjects enrolled in the GIFA study, who had a main discharge diagnosis of ischemic stroke represent the final sample. Drugs considered for the analysis were the following: ACE-inhibitors (ACEI), angiotensin II receptor blockers (ARBs), statins, calcium-channel-blockers (CCBs), antiplatelet (APL) drugs, antivitamin-k (VKAs), and heparins. As outcome indicators we choose in-hospital mortality, cognitive function evaluated by Hodkinson Abbreviated Mental Test (HAMT), and functional status evaluated by activity daily living (ADL). Indicators of a good outcome were: no in-hospital mortality, HAMT >6 and 0 ADL impaired. Patients with a good outcome showed a higher rate of in-hospital treatment with ACE-inhibitors, calcium-channel blockers and a lower rate of pre-treatment with heparin.. Our study suggests that if a patient with acute ischemic stroke has higher SBP at admission, higher total cholesterol plasma levels, a lower Charlson index and is treated with ACE-inhibitors, calcium channel blockers and antiplatelet drugs, the short term outcome is better in terms of in-hospital mortality and functional indicators such as cognitive and functional performance at discharge.

Topics: Activities of Daily Living; Aged; Angiotensin-Converting Enzyme Inhibitors; Brain Ischemia; Calcium Channel Blockers; Cardiovascular Agents; Cognition Disorders; Comorbidity; Female; Geriatric Assessment; Humans; Hypercholesterolemia; Hypertension; Italy; Male; Platelet Aggregation Inhibitors; Prognosis; Retrospective Studies; Stroke; Time Factors

Hypertension is the most common comorbidity among heart failure (HF) patients and has been independently linked with cognitive impairment. Cognitive impairment is prevalent among HF patients, though the extent to which hypertension contributes to cognitive function in this population is unclear.. 116 HF patients (31.0% women, 67.68 ± 11.16 years) completed neuropsychological testing and impedance cardiography. History of physician diagnosed hypertension, along with other medical characteristics, was ascertained through a review of participants' medical charts.. 69.8% of the HF patients had a diagnostic history of hypertension. After adjustment for demographic and medical characteristics (i.e., cardiac index, medication status, and resting blood pressure), hypertension was independently associated with attention/executive function/psychomotor speed (ΔF(1,103)=10.85, ΔR(2)=.07, p<.01) and motor functioning (ΔF(1,103)=4.46, ΔR(2)=.04, p<.05). HF patients with a diagnosed history of hypertension performed worse in these domains than those without such history.. The current findings indicate that diagnostic history of hypertension is an important contributor to cognitive impairment in HF. Hypertension frequently precedes HF and future studies should examine whether sustained hypertension compromises cerebral autoregulatory mechanisms to produce brain damage and exacerbate cognitive impairment in this population.

Topics: Aged; Aged, 80 and over; Attention; Cardiac Output; Cardiovascular Agents; Causality; Cognition Disorders; Comorbidity; Diabetes Mellitus; Executive Function; Female; Heart Failure; Humans; Hypertension; Language Disorders; Male; Memory Disorders; Middle Aged; Neuropsychological Tests; Psychomotor Performance; Time Factors

Topics: Aged; Cardiovascular Agents; Cardiovascular Diseases; Cognition Disorders; Humans

The search to define new standards of patient care is of particular relevance for the anesthesiologists providing cardiovascular anesthesia. Because of conflicting results on multiple issues, however, it is often difficult to understand new standards of patient care especially for occasional cardiovascular anesthesiologists. The objective of this series of articles is to summarize evidence of clinical and basic research and introduce current understanding of new standards of patient care in cardiovascular anesthesia. The following topics are discussed in each article: use of cardiovascular drugs for cardiac surgery, myocardial preconditioning in anesthesia, hemostatic management for cardiac surgical patients, blood glucose control during cardiac surgery, cognitive dysfunction after cardiac surgery, spinal protection in aortic surgery, ventricular assist device and heart transplantation in Japan. Further investigations in this area are critical in order to provide optimal patient care.

Topics: Anesthesia; Anesthesiology; Cardiovascular Agents; Cardiovascular Surgical Procedures; Cognition Disorders; Heart Transplantation; Heart-Assist Devices; Hemostasis, Surgical; Humans; Ischemic Preconditioning, Myocardial; Patient Care; Perioperative Care; Postoperative Complications

To identify drugs used to treat cardiovascular disease (CVD) after an invasive intervention that may adversely affect cognitive function.. Ambulatory care setting.. A pharmacy faculty member serves as an ambulatory care preceptor for students at a cardiac rehabilitation and wellness center on the campus of St. Joseph's Hospital, Atlanta, Georgia. Pharmacy services include patient case reviews, consultations, patient education, and therapeutic recommendations.. As part of the advanced practice experience, students are responsible for monitoring drug therapy regimens and conducting medication reconciliations. A literature review of primary sources and education databases was conducted to report cognitive adverse drug reactions associated with cardiac drugs in selective electronic tertiary sources.. Documentation of cognitive dysfunction associated with drugs used to treat CVD.. Drugs used to treat CVD may be associated with adverse drug effects including short-term memory loss, amnesia, confusion, decreased mental acuity, and impaired concentration.. Pharmacists providing consultation in the cardiac rehabilitation setting can provide insight into medications that can contribute to cognitive dysfunction.

Topics: Ambulatory Care; Cardiac Rehabilitation; Cardiovascular Agents; Cardiovascular Diseases; Cognition Disorders; Consultants; Humans; Pharmaceutical Services; Pharmacists; Professional Role; Students, Pharmacy

Some studies show coronary heart disease (CHD) to be a risk factor for cognitive function while others report no association between the two. We examined the effect of CHD history and duration on cognition in a middle-aged population.. Data come from the Whitehall II study of 10,308 participants (33% women), aged 35-55 years at baseline (Phase 1; 1985-88). CHD events were assessed up to Phase 7 (2002-04) when 5837 participants (28.4% women) undertook six cognitive tests: reasoning, vocabulary, phonemic and semantic fluency, memory and the mini-mental-state-examination (MMSE); standardized to T-scores (mean = 50, standard deviation = 10). Analysis of covariance was used first to model the association between CHD history and cognition and then to examine the effect of time since first CHD event (in the last 5 years, 5-10 years ago, >10 years ago). Among men, in analyses adjusted for age, education, marital status and medication for cardiovascular disease, CHD history was associated with lower T-scores on reasoning [-1.16; 95% confidence interval (CI) = -2.07, -0.25], vocabulary (-2.11; 95% CI = -3.01, -1.21), and the MMSE (-1.45; 95% CI = -2.42, -0.49). In women, these effects were also evident for phonemic and semantic fluency. Among men, the trend within CHD cases suggested progressively lower scores on reasoning, vocabulary and semantic fluency among those with longer duration of CHD.. Our findings go some way towards suggesting an association between CHD history and cognitive performance in middle-aged adults.

Topics: Adult; Age Factors; Analysis of Variance; Cardiovascular Agents; Cognition Disorders; Coronary Disease; Educational Status; Female; Humans; Male; Marital Status; Middle Aged; Risk Factors

We developed a pharmacist-based patient education intervention to improve older adults' adherence to chronic heart failure (CHF) medications, which included written patient-centered instructions. The study evaluated these instructions by examining whether patients preferred them to standard pharmacy instructions.. Elders diagnosed with CHF participated in the randomized controlled trial (83 in the intervention; 153 in usual care control group). Instruction preferences were collected after 6 months of participation.. Patient-centered instructions were preferred for learning about adherence information (e.g., schedule) and standard instructions for learning about drug interactions. Preference for the patient-centered instructions was greater for intervention versus control participants and for participants with lower health literacy. Literacy no longer predicted preferences with patients' cognitive abilities controlled, suggesting literacy reflected more fundamental cognitive mechanisms.. The finding that preferences varied with patients' experience using the instructions and cognitive abilities suggests instructions should accommodate diverse patient needs and abilities.

Topics: Aged; Cardiovascular Agents; Cognition Disorders; Drug Labeling; Drug Prescriptions; Educational Status; Female; Heart Failure; Humans; Male; Patient Compliance; Patient Education as Topic; Patient Satisfaction; Patient-Centered Care; Pharmacies; United States

The prevalence of risk factors for adverse drug events (ADEs) in patients discharged from the hospital to various care settings was studied.. Data on patient risk characteristics for ADEs were collected for hospital discharges for 2000. Differences in the prevalence of 10 risk characteristics among home health care (HHC), self-care (SC), and long-term-care (LTC) patients at the point of discharge were determined.. Data for 4250 discharges were analyzed. The three groups differed significantly in the distribution of risk characteristics. HHC patients had the highest prevalence of heart failure, cardiovascular medication use, and polypharmacy, and LTC patients had the highest prevalence of hypoalbuminemia, cognitive impairment, and psychiatric drug use.. The risk of ADEs in patients discharged to HHC appeared to be comparable to or higher than that in patients discharged to LTC.

Topics: Adverse Drug Reaction Reporting Systems; Aged; Aged, 80 and over; Cardiovascular Agents; Cognition Disorders; Continuity of Patient Care; Drug-Related Side Effects and Adverse Reactions; Female; Heart Failure; Home Care Services; Hospitalization; Humans; Hypoalbuminemia; Long-Term Care; Male; Middle Aged; Patient Discharge; Polypharmacy; Risk Factors; Tranquilizing Agents

Atrial fibrillation is a frequent disorder in the elderly and a known risk factor for cerebrovascular stroke. We investigated the association of atrial fibrillation with dementia and cognitive impairment in a large cross-sectional, population-based study in the elderly.. Of the 6584 participants in the Rotterdam Study aged 55 to 106 years, detailed information on dementia status and ECG abnormalities was available. Dementia was diagnosed in three phases. First, participants were screened. Screen-positive subjects were tested further. Those with possible dementia underwent an extensive diagnostic workup. Dementia and dementia subtypes were diagnosed according to prevailing criteria. Cognitive impairment was defined as a Mini-Mental State Examination test score of < 26 points for a nondemented subject.. Atrial fibrillation was diagnosed in 195, dementia in 276, and cognitive impairment in 635 subjects. We found significant positive associations of atrial fibrillation with both dementia and impaired cognitive function (age- and sex-adjusted odds ratios, 2.3 [95% confidence interval, 1.4 to 3.7] and 1.7 [95% confidence interval, 1.2 to 2.5]), respectively). The strongest association was found not for vascular dementia but rather for Alzheimer's disease with cerebrovascular disease. The associations were stronger in women, and the relation with dementia was more pronounced in the relatively younger elderly. A history of stroke in subjects with atrial fibrillation could not account for these associations.. Dementia and subtypes Alzheimer's disease and vascular dementia may be related to atrial fibrillation even if no clinical stokes have occurred.

Topics: Age Factors; Aged; Aged, 80 and over; Anti-Arrhythmia Agents; Atrial Fibrillation; Cardiac Output, Low; Cardiovascular Agents; Cerebrovascular Circulation; Cognition Disorders; Comorbidity; Cross-Sectional Studies; Dementia; Dementia, Vascular; Electrocardiography; Female; Humans; Male; Middle Aged; Netherlands; Prevalence; Risk Factors